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Double loop for arthroscopic repair of large triangular fibrocartilage complex (TFCC) tear
The triangular fibrocartilage complex (TFCC) has an important biomechanical function for the carpus and the distal radioulnar joint. TFCC lesions are responsible for ulnar side wrist pain and need to be repaired in order to restore a normal wrist. In some cases, TFCC lesions range from ulnar styloid to radial insertion. Wrist arthroscopy makes diagnosis and treatment possible in the least invasive way. The surgical treatment consists in reinserting the TFCC using the new double loop suture with absorbable PDS material. The film describes how to place a double suture of the entire TFCC tear by using an only one-way suture technique.
C Mathoulin
Surgical intervention
8 years ago
821 views
14 likes
0 comments
08:19
Double loop for arthroscopic repair of large triangular fibrocartilage complex (TFCC) tear
The triangular fibrocartilage complex (TFCC) has an important biomechanical function for the carpus and the distal radioulnar joint. TFCC lesions are responsible for ulnar side wrist pain and need to be repaired in order to restore a normal wrist. In some cases, TFCC lesions range from ulnar styloid to radial insertion. Wrist arthroscopy makes diagnosis and treatment possible in the least invasive way. The surgical treatment consists in reinserting the TFCC using the new double loop suture with absorbable PDS material. The film describes how to place a double suture of the entire TFCC tear by using an only one-way suture technique.
Triangular fibrocartilage complex (TFCC) dorsal distal repair
The triangular fibrocartilage complex (TFCC) is actually more complex than it appears to be. Arthroscopy of the wrist has helped to better understand the various insertions of this proximal and distal triangular complex and to detect these lesions. The adapted treatment of these lesions made it possible to prevent failures of the conventional arthroscopic reinsertions with the disappearance of the associated distal ulnar instabilities when only a part of the problem was treated.
The healing potential of the TFCC largely depends on its vascularization. This video shows the arthroscopic repair of a peripheral distal tear of the TFCC with the in-out technique.
C Mathoulin
Surgical intervention
1 year ago
342 views
6 likes
1 comment
04:08
Triangular fibrocartilage complex (TFCC) dorsal distal repair
The triangular fibrocartilage complex (TFCC) is actually more complex than it appears to be. Arthroscopy of the wrist has helped to better understand the various insertions of this proximal and distal triangular complex and to detect these lesions. The adapted treatment of these lesions made it possible to prevent failures of the conventional arthroscopic reinsertions with the disappearance of the associated distal ulnar instabilities when only a part of the problem was treated.
The healing potential of the TFCC largely depends on its vascularization. This video shows the arthroscopic repair of a peripheral distal tear of the TFCC with the in-out technique.
Technique of arthroscopic-assisted foveal repair for TFCC 1B lesion
Three classes of TFCC peripheral 1B tears are recognized in a treatment-orientated algorithm based on arthroscopic findings. Distal tear (class 1), associated with minimal instability of the DRUJ, requires ligament to capsule suture. Complete (class 2) and proximal tears (class 3) are associated with major DRUJ instability and require foveal re-attachment of the TFCC. A new arthroscopic-assisted technique to repair the foveal attachment of the TFCC by using a suture anchor is described. It is indicated for class 2 and 3 TFCC peripheral tears, instead of an open repair. The technique requires a dedicated working portal called Direct Foveal (DF) to approach the ulnar fovea. This DF portal is used to prepare the ligament and bone and to drill and insert a suture anchor loaded with a pair of sutures. Under arthroscopic vision, a suture is passed through each limb of the ligament and tied using a small knot-pusher or a simple mosquito forceps. This arthroscopic technique restores original TFCC anatomy and adequate DRUJ stability with less morbidity and easier rehabilitation as compared to open repair.
R Luchetti, A Atzei
Surgical intervention
7 years ago
559 views
9 likes
0 comments
15:25
Technique of arthroscopic-assisted foveal repair for TFCC 1B lesion
Three classes of TFCC peripheral 1B tears are recognized in a treatment-orientated algorithm based on arthroscopic findings. Distal tear (class 1), associated with minimal instability of the DRUJ, requires ligament to capsule suture. Complete (class 2) and proximal tears (class 3) are associated with major DRUJ instability and require foveal re-attachment of the TFCC. A new arthroscopic-assisted technique to repair the foveal attachment of the TFCC by using a suture anchor is described. It is indicated for class 2 and 3 TFCC peripheral tears, instead of an open repair. The technique requires a dedicated working portal called Direct Foveal (DF) to approach the ulnar fovea. This DF portal is used to prepare the ligament and bone and to drill and insert a suture anchor loaded with a pair of sutures. Under arthroscopic vision, a suture is passed through each limb of the ligament and tied using a small knot-pusher or a simple mosquito forceps. This arthroscopic technique restores original TFCC anatomy and adequate DRUJ stability with less morbidity and easier rehabilitation as compared to open repair.
Arthroscopic reconstruction of the TFCC using a free tendon graft
Instability of the distal radioulnar joint (DRUJ) results from injury or laxity of the ligaments responsible for stabilizing the joint. Of note, the triangular fibrocartilage complex (TFCC) plays a crucial role in maintaining DRUJ stability. Sometimes, it may be impossible to repair the TFCC due to degenerative changes in the TFCC. In such cases, DRUJ reconstruction is possible provided that there are no arthritic changes in the DRUJ with the use of tendon graft. The aim of this procedure is to reconstruct the ligament and restore function, thus providing multidirectional stability. This procedure uses a tendon graft, preferably the Palmaris Longus (PL), which is woven through trans-osseous tunnels in the distal radius, converging at the fovea through a distal ulnar trans-osseous tunnel.
C Mathoulin
Surgical intervention
4 months ago
272 views
2 likes
0 comments
12:20
Arthroscopic reconstruction of the TFCC using a free tendon graft
Instability of the distal radioulnar joint (DRUJ) results from injury or laxity of the ligaments responsible for stabilizing the joint. Of note, the triangular fibrocartilage complex (TFCC) plays a crucial role in maintaining DRUJ stability. Sometimes, it may be impossible to repair the TFCC due to degenerative changes in the TFCC. In such cases, DRUJ reconstruction is possible provided that there are no arthritic changes in the DRUJ with the use of tendon graft. The aim of this procedure is to reconstruct the ligament and restore function, thus providing multidirectional stability. This procedure uses a tendon graft, preferably the Palmaris Longus (PL), which is woven through trans-osseous tunnels in the distal radius, converging at the fovea through a distal ulnar trans-osseous tunnel.
Round table: TFCC tears: a complex system for complex lesions
The TFCC is an essential structure in the stability of the distal radio-ulnar joint (DRUJ). What we took for a simple suspensory ligament has actually become a complex structure than previously thought since the work of Palmer in 1981. Some members of the EWAS, first and foremost Toshiyasu Nakamura, has helped to better understand this essential component as well as the damage it may suffer. Thanks to Andrea Atzei, Francisco Del Pinal and Tommy Lindau, the TFCC is now a well understood and well-known entity. Having them together in a round table on this topic answering a flow of questions asked by our two famous chairmen, Diego Fernandez and Laurent Obert, allows to better understand the problems caused by the lesion of this structure.
D Fernandez, L Obert, A Atzei, TR Lindau, F del Piñal, T Nakamura
Lecture
8 years ago
197 views
2 likes
0 comments
20:12
Round table: TFCC tears: a complex system for complex lesions
The TFCC is an essential structure in the stability of the distal radio-ulnar joint (DRUJ). What we took for a simple suspensory ligament has actually become a complex structure than previously thought since the work of Palmer in 1981. Some members of the EWAS, first and foremost Toshiyasu Nakamura, has helped to better understand this essential component as well as the damage it may suffer. Thanks to Andrea Atzei, Francisco Del Pinal and Tommy Lindau, the TFCC is now a well understood and well-known entity. Having them together in a round table on this topic answering a flow of questions asked by our two famous chairmen, Diego Fernandez and Laurent Obert, allows to better understand the problems caused by the lesion of this structure.